Palliative pelvic exenteration: patient selection and results

Total pelvic exenteration is a radical abdominoperineal operation designed to treat locally extensive pelvic malignancy. In the past, the morbidity and mortality has been such that this procedure was considered justified only in the curative setting. As experience has increased and operative survival has improved, the indications for radical pelvic surgery have expanded to include palliation of the symptoms of pelvic tumors, including pain, obstruction, fistulas, and bleeding. The careful selection of suitable candidates for palliative pelvic exenteration requires an extensive preoperative evaluation of the patient's underlying physical and emotional health, as well as an assessment of the local and distant extent of the tumor. In appropriately selected patients, significant palliation of the symptoms associated with an uncontrolled pelvic malignancy can be accomplished with substantial improvement in quality of life.